This comes after the deaths of 118 psychiatric patients while being moved from the Life Esidimeni group’s facilities last year.

Psychiatric patients in South Africa were still cared for in institutions built before the dawn of democracy in 1994, and the government’s bid to construct new facilities had failed dismally, the arbitration hearing into the death of 118 mental health patients heard on Thursday.

The national department of health’s director-general Precious Matsoso was giving evidence on the fourth day of the hearings chaired by former deputy chief justice Dikgang Moseneke in Johannesburg.

“You see, I don’t think the previous witness [Levy Mosenogi, director of planning, policy and research at Gauteng health department] was the appropriate person to know and answer this question. When I look at the facilities, these facilities were built before 1994, am I right? Cullinan, Sterkfontein, or Weskoppies – the names tell you they were built before 1994. Have we build any after 1994, for mental health in particular?” Moseneke asked Matsoso.

She responded: “I can just answer in a brief way to say that an attempt to build one, I can say, was an absolute disaster. This is a facility that was built in Northern Cape. It consumed huge resources, [but] was not appropriate for mental health care. It was a lesson for us that it should not be done in that way.”

“With the provision in the Mental Health Act that we should not move towards keeping people in institutions, rather move towards community based mental healthcare, we should rather make investments in our primary healthcare facilities, our existing health facilities where outpatients services are appropriate. The investment cannot be in building more facilities where people are going to be institutionalised …”

She said unsuccessful attempt to establish a functional facility in the Northern Cape was a major concern for the department of health.

Moseneke pointed out that in spite of the policy, both government-owned and privately-owned mental facilities were still being used widely.

“But we are still using clinics, we are using Life Esidimeni – I have seen it here in your report back. Once there are difficulties with community [based] healthcare, the department ran right back to those institutions. So the question that begs an answer is, don’t we need a mix of institutions and the public healthcare facilities?” Moseneke asked Matsoso.

The director-general conceded that South Africa did in fact need mental health institutions.

“Precisely, we do. A balance between facilities that we call facilities for acute care, for mental health, and those that are for long term care. This is the difference between your Weskoppies, Sterkfontein versus these other facilities that are for long term care,” said Matsoso.

Unconvinced, Moseneke repeated his question: “So the question still remains – do we need facilities for acute and long term care? Do we need more of them, so that we won’t have the temptation to move them [mental patients] out of clinics, to move them out of Life Esidimeni?”

Matsoso said South Africa did need more long-term care facilities that are community based and integrate the patients closer to their families and society.

One hundred and eighteen psychiatric patients died after being moved from the Life Esidimeni group’s facilities last year.

Former health MEC Qedani Mahlangu resigned in the wake of the tragedy, while head of department Barney Selebano was suspended for gross misconduct and incompetence.

A report released by Health Ombudsman Malegapuru Makgoba in February, found that as many as 94 mentally ill patients who were transferred from Esidimeni to unlicensed care centres by the Gauteng department of health, had died of causes that included neglect and starvation.

The death toll figure rose over time as more information was discovered by Makgoba, bringing the number of deaths to 118.